The Emerging Role of Nurses in the Patient Protection - Research Paper Example

The Emerging Role of Nurses in the Patient Protection and Affordable Care Act In their report on the Patient Protection and Affordable Care Act (Public Law 111-148), the American Nurses Association highlights the main point of health care reform by stating its goal as, “transforming the current ‘sick care’ system into a true ‘health care’ system.” (American Nurses Association, 2010) If this is indeed the goal of our current health care reform legislation, nurses need to have a practical understanding of the faults of the current ‘sick care’ system, and how their new emerging roles relate to the transformation of this current system into a new ‘health care’ system. The faults of this current system and the shortcomings of a health care system built on the ‘sick care ‘model became directly evident to me while volunteering at a free clinic in my hometown. This clinic was understaffed, overcrowded with patients, and was in desperate need of renovation, but still managed to see over 100 patients on most days. One of the things that stood out to me the most about the condition of this clinic was their need for medical staff. The free clinic was within two miles of three major hospital systems, and sat in the literal shadows of one of these systems in the late afternoon; yet with all of these highly skilled and highly trained medical personnel in the surrounding area, the free clinic still lacked for providers. This shocked me. Yet despite my confusion, one of the providers at the free clinic explained to me that the shortage of practitioners, particularly nurses, was felt at the large clinics surrounding our free clinic as much as at the free clinic, and as I later found out, could be found in areas as diverse as primary care nursing and oncology nursing (Bishop, 2010). I quickly realized this was an effect of the current ‘sick care’ system. The number of providers is limited because the role of the provider is to treat a patient when that patient is sick. In order to achieve efficiency in this system, providers are encouraged to see treat as many patients as they can, and the number of providers is kept to the minimum required to meet the hypothetical demand of the patients. This is the ‘sick care’ system, and the direct outcome of this system was the provider shortage I was experiencing. To overcome this problem, I realized that a supply and demand solution would be required to move our current system from a sick care system to a health care system. In a 2011 interview in the New England Journal of Medicine, Secretary of Health and Human Services Kathleen Sebelius echoes this idea by saying, “I believe that refocusing health interventions at an earlier stage, placing more focus on health and wellness strategies, would help reduce demand and promote population health.” (Iglehart, 2011) In this quote, Sebelius shows the supply and demand solution necessary to convert the sick care system to a health care system. By emphasizing health and wellness strategies at earlier stages, Sebelius is hypothesizing that, while a greater investment may be required up front, these efforts will eventually keep people healthier in the long term, and will create a true health care system: one in which the goal of providers is to keep patients healthy and prevent sickness, not just treat the sickness as it occurs. She further explains this idea and how it could help the provider shortage I witnessed by saying, “Unfortunately, the shortage of [providers] has been ignored for a decade or more, along with the fact that doctors whose practices are devoted to primary care are under paid compared with specialists. So starting with the stimulus law and continuing in the ACA, there has been a significant focus on expanding the pipeline of primary care practitioners, gerontologists, and general surgeons… We have also put more money into nurse training and education…” (Iglehart, 2011) Clearly, the new health care law has the vision to transform the sick care system into a health care system, but what is the emerging role of nurses in this system? A solution to the problem of understaffing at both free clinics and large for-profit clinics across the country is to shift the focus of nurses to reflect a larger systemic emphasis on the primary care workforce. As Sebelius highlighted, the current sick care system needs to emphasize more health and wellness strategies to effectively transform itself into a health care system. These health and wellness interventions, including cholesterol screenings, diabetes clinics, and smoking cessation programs, occur mostly in the primary care setting. An increased emphasis on these interventions should be accompanied by a subsequent increase in the emphasis on the primary care workforce. This is why the Patient Protection and Affordable Care Act increases the amount of aid available not just to primary care nurses across the country, but to nursing students, nursing graduate students, and pediatric and geriatric nurses. As the number of these health and wellness interventions begins to increase due to the new law, there will need to be a larger workforce of primary care nurses to perform these health and wellness interventions. Furthermore, the present primary care nursing workforce will need to be trained in these interventions and their importance in order for an effective emphasis to be placed on health and wellness initiatives. If primary care nurses are not trained in how to counsel a patient on smoking cessation or what a cholesterol value means, these nurses won’t be able to fill their emerging role as providers of these health and wellness services in the primary care setting. While the healthcare reform legislation may shift nurses’ focus to primary care services, the law also emphasizes nurses’ emerging roles as researchers. Even nurses who presently spend no time in the lab and do no research will be expected to bring research expertise to the workplace with the emerging role of the nurse as practitioners of evidence-based medicine. As the health care system strives to provide higher quality medicine to patients while increasing positive outcomes of these medical interventions, evidence-based medicine appears to be an effective solution to providers seeking the most effective solutions to common health problems. Nurses’ emerging roles as researchers will be defined by this emphasis on evidence-based medicine, as can be seen by the emphasis the new health care law places on comparative effectiveness research, quality improvement, and evidence-based medicine. These areas of quality improvement will require nurses to be capable of reading scholarly journal articles, understanding the statistics behind much of the research, and have a familiarity with evidence-based medicine databases such as the Cochrane Collaboration. Studying these areas will help prepare nursing students for their emerging roles as researchers, and synthesizers of current research. As oncology nurse practitioner Wendy Vogel explained at a 2011 oncology nursing conference, nurses must, “learn the new technology [and] adapt to our patients’ and professions’ needs.”(Wendy Vogel, 2011) By receiving training in evidence-based medicine, quality improvement, and comparative effectiveness research, nurses can adapt to our professions’ needs for nurses acting as researchers. In response to the question of nurses’ roles in healthcare reform, Wendy Vogel goes beyond a discussion of embracing new technology and gives a summarizing response by saying nurses must, “be part of the initiatives.” (Wendy Vogel, 2011) In order for the sick care system to transform itself into the health care system, nurses must follow this advice and embrace their emerging roles to the point that nurses feel as if these new initiatives are their own. Whether it is a cholesterol screening, an evidence search for a treatment approach, a smoking cessation counseling session, or a review of a comparative effectiveness study, nurses must embrace their emerging roles as both primary care deliverers of health and wellness interventions, as well as researchers to the point that they feel these are not roles they are aiming to fill, but roles they already do. Bibliography 1. Wendy Vogel, M. F. (2011). Nurse Practitioners in Oncology: Future Trends Impacting Practice. Oncology Nursing Society 36th Annual Conference (pp. 1-7). New York: Oncology Nursing Society. 2. American Nurses Association. (2010). Key Provisions Related to Nursing. American Nurses Association. American Nurses Association. 3. Bishop, C. S. (2010). The critical role of oncology nurse practitioners in cancer care: Future implications. Oncology Nursing Forum , 6 (1), 37-38. 4. Iglehart, J. K. (2011). Implementing Health Care Reform- An Interview with HHS Secretary Kathleen Sebelius. The New England Journal of Medicine , 364 (4), 297-299. Read More